NIATx in New Places

By: Mat Roosa, LCSW-R

NIATx launched in 2003 and has been supporting process improvement change efforts ever since. The NIATx in New Places blog series will share the experiences of NIATx practitioners old and new. 

We will learn how NIATx has been rebooted and repurposed in many new settings, and how it continues to have a major impact in the places where the model was originally used. We will hear from some of the original NIATx members who are still finding new ways to use the NIATx tools 20 years later and from others newer to NIATx who are finding paths forward to support new projects and improvements. We will share stories about the impact of NIATx on service systems, provider organizations, and on the paths of individuals who are blazing trails in health and human service practice, policy, and research.

My own career path has been influenced by NIATx more than any other factor, and I look forward to reading about the stories and experiences of others who have used NIATx in new places. 

As an agency administrator of one of the founding NIATx agencies, I was looking for tools to improve our services. NIATx opened the door for me to a new vision for process improvement. 

I remember clearly the first time I conducted a NIATx Walkthrough exercise for a residential program that I supervised. I was seeking to better understand the customer experience of arriving at the facility, and quickly learned that I couldn’t find a way to enter the building! Then, I sat in the clinic waiting room to understand what it felt like to wait for services. I had walked through that waiting room hundreds of times before but never stopped to sit down. It was apparent there were several important things that could be improved to enhance clients’ experiences when visiting the clinic.

Mat Roosa (seated bottom right) with members of Central New York Services NIATx Change Team, 2003.

These simple and humbling examples of genuine efforts to see the service system through the eyes of the client or customer shifted my vision and led me to make a number of changes that had real and meaningful impact on the people we served.

I maintained my connection to NIATx through my involvement in coaching and mentoring. I coached a number of different projects as I moved from agency administration and clinical practice to governmental planning positions. I now work as a consultant and have a staff position with CHESS at University of Wisconsin–Madison (the home of NIATx). Through the years, I've had the opportunity to partner with and learn from "thought leaders" in this field. 

These partnerships helped deepen my understanding and appreciation of how to effectively apply the NIATx principles and tools within hundreds of organizations and systems seeking to implement process improvements. The core NIATx tools (walk through, flow chart, nominal group technique (link these) and the NIATx 5 principles remain a guiding compass for my work supporting organizations to plan, implement new practices, and improve quality. In just the last year, I've had the opportunity to use NIATx in a wide range of new places:

• Clinical treatment programs
• Substance use prevention
• Suicide prevention
• Probation
• Courts
• Workforce enhancement
• DEI/ CLAS Standards
• HIV/ AIDS service settings
• Education and training organizations
• Evidence based practice implementation
• Medication for Opioid Use Disorders

Through NIATx, I have learned that best practice models are necessary but not sufficient for improvement. The process improvement toolbox of NIATx is the vehicle that carries an array of promising practices into organizations both big and small. NIATx continues to help these systems move forward into new places and sustain those improvements over time. I often think of NIATx as a lever: a simple tool that can, if used with energy and purpose, enable you to move things that seemed too heavy to lift.

Join us for future posts in this year-long series as we share the experiences of others who are making a difference using NIATx in new places. We hope that by sharing these stories and experiences we will inspire others to explore how NIATx can take you and your organization to new places.

Mat Roosa is a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant and trainer in the areas of quality improvement, organizational development, and planning, evidence-based practice implementation. Mat’s experience also includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human services agency administration.

ATTC's Pearls of Wisdom: Investing Soundly By Building the Substance Use Disorder Workforce

By Nancy A. Roget, MS and Cindy Juntunen, PhD, Mountain Plains ATTC

According to Benjamin Franklin, “For the best return on your money, pour your purse into your head.” This is sound advice and one that SAMHSA has followed through its funding of the Addiction Technology Transfer Centers (ATTCs). The ATTCs emphasize preparing the SUD workforce to use evidence-based practices when providing SUD services (harm reduction, treatment, and recovery support) to patients and their families through training and technical assistance activities. Preparing the SUD workforce targets both licensed/certified professionals as well as students.

The Mountain Plains ATTC is one of the original 11 ATTCs. In 1993 the grant was located at the University of Nevada with Dr. Gary Fisher as the initial project director. Called the Mountain West ATTC it first served the states of Montana, Nevada, and Wyoming from 1993-1998. Five subsequent successful grant awards (1998 to present) included new partnerships and changes to the states served. 

Currently, the Mountain Plains ATTC is housed at the University of North Dakota in partnership with the University of Nevada (Nevada) working with Region 8 which includes six states: Colorado, Montana, North and South Dakota, Utah and Wyoming.

Despite changes over the last 30 years, one area of focus remains a priority for the Mountain Plains ATTC: academic programs and products. 

During the initial funding period, the Mountain Plains ATTC built academic programs at Nevada and Great Falls University in Montana, with academic courses also created for the University of Wyoming. The investment of SAMHSA grant dollars built an undergraduate minor and a graduate emphasis in Addiction Treatment Services at Nevada. 

These academic programs still exist; 800-plus students are enrolled and taking undergraduate and graduate courses on prevention, harm reduction, treatment, and recovery support services in-person and online in Spring Semester 2023.

From 1998, on, the Mountain Plains continued its focus on academic programs and products which include but are not limited to:

• Cross-walk that listed the practice domains of the TAP21 Practice Domains and Competencies for academic courses/curricula- 1999 
• Work Groups (2000 - present) that include academic faculty from universities and tribal colleges throughout the region, who provide input to ATTC staff on curricular needs as well as the upcoming workforce 
• Nevada undergraduate courses developed for online delivery 2001

In 2001 the Mountain Plains ATTC created a curriculum infusion effort in response to faculty and institutions reporting difficulties in implementing new programs and courses due to costs and lack of faculty with specific expertise. This infusion process was successfully utilized to find “curricular room” (Dimoff, et al., 2017; Gassman et al., 2001) for SUD and mental health (MH) information as well as a way of highlighting SUD/MH information within a context of a discipline (Redding & Selleck, 1999) This effort was consistent with findings from curriculum infusion research, which demonstrated that the uptake of science-based knowledge into professional practice occurs more frequently if it is ‘functionally relevant’ (Savage, et al., 2018; Taylor & Rafferty, 2003) meaning, taught within a specific discipline or profession. 

Finally, the Mountain Plains developed Curriculum Infusion Packages to support faculty who may have limited SUD expertise. The Mountain Plains ATTC partnered with several different ATTCs to create: slide decks with notes, videos, audio recordings, and experiential learning experiences, and test questions on the neurobiology of addiction, stimulants, and self-care. The purpose of the infusion model is to assist faculty in infusing new knowledge, typically evidence-based practices (EBPs), into existing courses by offering brief ”bites of information.”

In keeping with the curriculum infusion methodology, the Mountain Plains ATTC and Pacific Southwest ATTC created a product called  SUD Keys to Education (SUD Keys), in January 2023. 

This product includes slide decks that are intentionally brief so instruction can be infused in five to 10-minute segments, with some longer options available. Slide decks (not PDFs) are easily downloaded and prepared for immediate use by instructors. Many of the slide decks include video (MP4) recordings and can be used as an alternative instructional delivery method. 

For example, the audio slide decks and videos can be played during live training events or downloaded and listened to by students/participants prior to the class or the event (flipped classroom approach). Slide decks currently available include: Stimulants; Alcohol; Stigma; Recovery Support; and Harm Reduction.

Links to the SUD Keys product are available at the Mountain Plains and Pacific Southwest ATTCs’ websites. This product carries on the ATTC’s 30-year tradition of investment in the SUD workforce through curated academic products.

References

Dimoff, J. D., Sayette, M. A., & Norcross, J. C. (2017). Addiction training in clinical psychology: Are we keeping up with the rising epidemic? American Psychologist, 72(7), 689–695. https://doi.org/10.1037/amp0000140

Gassman, R. A., Demone Jr, H. W., & Albilal, R. (2001). Alcohol and other drug content in core courses: Encouraging substance abuse assessment. Journal of Social Work Education, 37(1), 137-145. https://doi.org/10.1080/10437797.2001.10779042

Redding, B. A., & Selleck, C. S. (1999). Perinatal substance abuse education: A review of existing curricula. Substance Abuse, 20(1), 17-31. https://doi.org/10.1023/A:1021344722132

Savage, C. L., Daniels, J., Johnson, J. A., Kesten, K., Finnell, D. S., & Seale, J. P. (2018). The inclusion of substance use-related content in advanced practice registered nurse curricula. Journal of Professional Nursing, 34(3), 217–220. https://doi.org/10.1016/j.profnurs.2017.08.006

Taylor, I., & Rafferty, J. (2003). Integrating research and teaching in social work: Building a strong partnership. Social Work Education, 22(6), 589-602. https://doi.org/10.1080/0261547032000142698

 

ATTC’s Pearls of Wisdom: Relationship building starts with ‘listening’

By Catelyn Holmes, for the Mid-America ATTC

 

If there’s one thing Pat Stilen has learned in her decades’ long career, it’s the value of building relationships, and that starts by listening.

 

“Building relationships and listening, that makes all the difference in the world,” she said.

 

Stilen, a social worker, retired from her leadership role with the Mid-America Addiction Technology Transfer Center in March 2022. She joined MATTC in 1996, after building a relationship with the members of the staff.

Pat Stilen, former Co-Director, Mid-America ATTC

Her longstanding relationship with the MATTC began three decades ago, when she finally found someone who could listen to the problem she was having: how to introduce the then-new concept of managed care to an entire state of substance use disorder providers.

 

"I was calling my friend saying, 'How do you go about getting people to accept something new and eventually feel good about it, while they feel reluctant?'" she said.

 

Stilen sought support from her corporate office on how to make the process successful, but she says all they could say was "We don’t know, good luck".

 

A friend suggested she contact the directors at MATTC - Sue Giles and Mary Beth Johnson. The pair were able to provide her with the support she sought. That introduction would also change the course of Stilen’s career, leading to her becoming the Co-Director of the MATTC in 1999.

After almost a quarter century in a leadership role with the Mid-America ATTC, Stilen said she could clearly identify ways the care around SUD changed in Region 7 during her career.

 

The most significant change brought about by the MATTC was changing the tone around what is now known as Medications for Opioid Use Disorder (MOUD) in the region.

 

The four states that make up Region 7 – Iowa, Kansas, Missouri and Nebraska - were some of the last in the country to adapt to MOUD.

 

“It felt like (other ATTCs) were lightyears ahead of us,” Stilen said.

 

Using the technology transfer model, MATTC was purposeful in changing the minds of regional policy makers. The center brought innovators, leaders already doing the work in their region, to the table to brainstorm how to make a real difference with policy makers. After six months of planning, a summit was held which resulted in Stilen writing a grant for buprenorphine.

 

“It was like the sky opened up and suddenly it was something everyone needed to do,” she said. “We’d spent years trying to do it different ways, but until we got the policy makers to open their minds we didn’t get far. That’s one of the things, [MOUD]…that’s what I’m particularly proud of.”

 

As proven in the success of changing the field of MOUD in the region, relationship building continues to be a key factor in successfully providing education and support in Region 7. In the ATTCs earlier years, regions were still being identified, which resulted in various occasions where states were being absorbed and transferred by different ATTC partners.

 

"There was loyalty on both parts,” she said.

 

As changes occurred, the center needed to adjust how it continued to serve states it already had connection with, while also introducing technology transfer assistance to new collaborators.

 

One significant means in facilitating relationships within states for Region 7 included the Leadership Institute. After initiating the Leadership Institute in Kansas at the request of the state authority, Stilen recalled providers and directors viewing it as a great opportunity. The model was adapted to other states, which helped providers meaningfully connect with MATTC, and it provided valuable leadership development that was needed at a time when preparing for professionals nearing retirement to leave the workforce.

 

Mid-America ATTC will be hosting its Leadership Institute in April 2023. Find out more here.

 

While the Leadership Institute is no longer required by SAMHSA, Mid-America's advisory board has continued to strongly suggest it be a priority. Pat explains, “It is key to develop relationships with people who participate, both as protégé and mentors".

 

Maintaining those longstanding relationships remains important, a lesson Lisa Carter, her successor at Mid-America ATTC, said she learned from Stilen while preparing to take over as Co-Director. 

 

“Pat always told me that as we were doing succession planning and training,” Carter said. “I know it to be true from my own career experiences… ‘You refer to people, not businesses.’ It’s very true. I spent last summer touring and doing meetings and it is critical.”

 

For her part, Stilen said she appreciates knowing that the MATTC has been able to sustain the relationships its built over the last quarter century.

 

"[When] they call you when they need something, you've really made it,” she said.